Cases Wild

"Factitious Hypoglycemia," the poster title said. What on earth is that about, I thought to myself.

I was checking out the posters at the British Society for Endocrinology's BES meeting last month in Manchester, England, when the poster caught my eye. I had to read the poster to remind myself what "factitious" meant.

The full title was "Factitious hypoglycaemia in a patient without diabetes" and it described a supermarket manager who, for no apparent reason, was injecting himself with insulin. The authors noted that insulin has an anabolic effect, and rapid decreases in blood glucose can cause euphoria, but the patient's motives in this case were unclear.

The researchers in this case also sleuthed out the likelihood that she was injecting insulin. Her high levels of serum insulin and low blood sugar, in the absence of other abnormalities, left no other plausible alternatives.

It also transpired that the woman was in trouble with the law. Her doctors surmised that she was trying to evade jail time.

In fact, a Google search disclosed a considerable literature on factitious hyperglycemia.

I bring this up because it highlights the continued importance of case reports in medicine. It's popular nowadays to pooh-pooh any publication that isn't a large, prospective, randomized, non-industry-sponsored trial, and indeed MedPage Today hardly ever reports on cases, no matter how interesting.

But, on the other hand, most of what we know about medicine began with case reports.

They certainly make small meetings like BES more interesting. Out of several hundred posters and podium presentations, I think there was only one randomized trial. Most of the reports were retrospective single-institution experiences or in vitro studies.

Useful to somebody, I'm sure. But if it weren't for the case reports, I might never have known that:

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